What with primary season in full swing, if there’s one thing the Republican candidates agree on it’s that, if elected, each would work to repeal health reform. Campaign promises are one thing. But since none of the remaining candidates have yet offered any kind of detailed replacement plan, could they actually repeal or otherwise thwart health reform?

“Oh, I don’t doubt that for a second,” said Alden Wolfe, vice chairman of the Rockland County, N.Y. county legislature. “Any change in administration brings a change in priorities and policy. As a Democrat, and someone who cares about this issue, I think that a Republican in the White House would probably have a devastating effect on the availability of healthcare services to people in this country.”

What’s more, should Republicans also wrestle control over Congress, that would make formally repealing the Accountable Care Act (ACA) all the easier. But even short of that, a Republican administration could feasibly engage in tactics to stall funding for health IT projects, notably meaningful use Stages 2 and 3, health information exchanges (HIEs) and health insurance exchanges (HIX).

“Various parts of the ACA can be de-funded,” said Kevin Pho, MD, (otherwise known as KevinMD in the blogosphere). Various committees can stop funding to parts of the Affordable Care Act and render them ineffectual that way. And if that does happen, it certainly can have the effect similar to an official repeal but it’s an indirect measure.”

The reformation of America’s healthcare system, however, is gaining industry momentum on many layers, and not just the law President Obama signed in March 2010.

Brian Ahier, health IT evangelist at Mid-Columbia Medical Center and a City Councilor in The Dalles, Ore., likens health IT momentum to a giant snowball that keeps rolling downhill, gaining more and more speed and mass: “You can maybe alter its course, but you can’t stop it,” he said. “And that’s where we’re at now with health reform. They can talk all they want about repeal-and-replace, but what of the regulations in place now and all the things that are already happening?”

Countering that, John Graham, director of healthcare studies at the Pacific Research Institute argues that “the momentum is much less than you might think, for a couple reasons.”

Paramount among those reasons: HIXs are not getting off the ground at the rate the Obama administration advertised. “I don’t think people anticipated that states would entirely say no to the health [insurance] exchanges, and so there are very few that are taking up these exchanges,” said Graham. “States with Republican governors that are asserting an ability to set up an exchange primarily for the goal of getting a few million dollars in implementation grants from the Secretary are running into problems with their legislators and their voters.” Troubled states include California, Colorado, Idaho, New Mexico.

On the HIE and EHR fronts, the progress is more apparent, as Centers for Medicare and Medicaid Services has paid incentives approaching $2.5 billion, while some 176,000 providers registered during 2011, CMS said in mid-January. HIEs also are moving forward, though not entirely without incident or obstacles, across the country. Indeed, health IT is heating up the private sector.

“When you look at what’s going on in the private market, this is important: Aetna has purchased companies like Medicity and iTriage, so they’re looking at health information exchange [and] mobile applications,” said Ahier. “Health information technology is an incredibly important tool in the private market. UnitedHealth Group bought Axolotl. The entire industry is moving toward having the health IT infrastructure in place that’s going to enable innovative care delivery and, ultimately, new payment models. That’s a direction that hopefully will continue to have bi-partisan support and not be a part of the broader debate on reform, mandates, and what’s going on in Washington D.C. right now.”

Between now and the November presidential elections, the Affordable Care Act faces another epic challenge in the Supreme Court, which is slated to hear arguments March 26, 27 and 28.

While the nation’s eyes will certainly fix on the Supreme Court ruling, and Ahier and Graham noted that striking down the individual mandate is a very real possibility, Pho said that, even should that happen, the core of the ACA will continue.

“A lot of this is going to be wait-and-see,” he said. “Many people talk about repeal, but when you get down to the nuts and bolts of it, actually doing so is going to be much more difficult than the rhetoric we hear.”